Dealing With Foot Troubles

Flexible flatfeet are considered normal in young children because babies are not born with a normal arch. The arch may not form fully until sometime between ages 7 and 10. Even in adulthood, 15% to 25% of people have flexible flatfeet. Most of these people never develop symptoms. In many adults who have had flexible flatfeet since childhood, the missing arch is an inherited condition related to a general looseness of ligaments. These people usually have extremely flexible, very mobile joints throughout the body, not only in the feet. Flatfeet also can develop during adulthood. Causes include joint disease, such as rheumatoid arthritis, and disorders of nerve function (neuropathy). Unlike a flexible flatfoot, a rigid flatfoot is often the result of a significant problem affecting the structure or alignment of the bones that make up the foot's arch. Some common causes of rigid flatfeet include. Congenital vertical talus. In this condition, there is no arch because the foot bones are not aligned properly. In some cases, there is a reverse curve (rocker-bottom foot, in which the shape is like the bottom rails of a rocking chair) in place of the normal arch. Congenital vertical talus is a rare condition present at birth. It often is associated with a genetic disorder, such as Down syndrome, or other congenital disorders. The cause is unknown in up to half of cases. Tarsal coalition (peroneal spastic flatfoot). In this inherited condition, two or more of the foot bones are fused together, interfering with the flexibility of the foot and eliminating the normal arch. A rare condition, it often affects several generations of the same family. Lateral subtalar dislocation. Sometimes called an acquired flatfoot, it occurs in someone who originally had a normal foot arch. In a lateral subtalar dislocation, there is a dislocation of the talus bone, located within the arch of the foot. The dislocated talus bone slips out of place, drops downward and sideways and collapses the arch. It usually occurs suddenly because of a high-impact injury related to a fall from a height, a motor vehicle accident or participation in sports, and it may be associated with fractures or other injuries.

Causes

Flat feet can be caused by injury, aging, and weight gain. They can cause pain in the feet and may lead to pain in other parts of the body such as the ankles, knees, or hips. For this reason, it behooves us to treat fallen arches. The question becomes how to do so.

Symptoms

Not everyone who has flat feet experiences symptoms. Others, however, feel persistent pain in their feet and wearing shoes can prove additionally painful. Others only feel symptoms when they walk more than normal, go jogging or participate in a sport that involves running or kicking.

Diagnosis

If you notice that your feet are flat, but you?re not really experiencing any pain, then you?re probably okay to go without a visit to the podiatrist (unless, of course, you have a lack of feeling in your foot). You can schedule a hair appointment instead, or maybe see a movie. However, once painful symptoms start to appear, it?s better to skip the hirsute (or cinematic) experience and go see your foot doctor. Your podiatrist will likely make the diagnosis by examining your foot visually, asking about symptoms you may be experiencing, and may test your muscle strength. You may be asked to stand on your toes (in a ballerina pose, if you prefer, although that?s certainly not required), or walk around the examining room, and you may need to show the podiatrist your shoes. He or she may comment on your excellent taste in footwear, but is more likely to check your shoes for signs of wear that may indicate fallen arches. Your podiatrist may recommend X-rays, a CT scan or an MRI in order to get a look at the interior of your foot, although the best diagnosis usually comes from the doctor?s own in-person examination.

Flat feet and fallen arches can be treated effectively by wearing an orthotic insert in your shoes. Orthotics can be custom-made and prescribed by your foot specialist (podiatrist), or you can use a so called pre-made foot orthotic. Most people do not require expensive custom-made orthotics to combat excess pronation, unless they have a specific medical foot condition. Orthotic insoles were developed to correct excess pronation, thereby providing sustainable, long-lasting pain relief to many aches and pains in a natural way. Comfort, Casual and Sports are products which promote excellent biomechanical control of the foot.

Surgical Treatment

Surgery for flat feet is separated into three kinds: soft tissue procedures, bone cuts, and bone fusions. Depending on the severity of the flat foot, a person?s age, and whether or not the foot is stiff determines just how the foot can be fixed. In most cases a combination of procedures are performed. With flexible flat feet, surgery is geared at maintaining the motion of the foot and recreating the arch. Commonly this may involve tendon repairs along the inside of the foot to reinforce the main tendon that lifts the arch. When the bone collapse is significant, bone procedures are included to physically rebuild the arch, and realign the heel. The presence of bunions with flat feet is often contributing to the collapse and in most situations requires correction. With rigid flat feet, surgery is focused on restoring the shape of the foot through procedures that eliminate motion. In this case, motion does not exist pre-operatively, so realigning the foot is of utmost importance. The exception, are rigid flat feet due to tarsal coalition (fused segment of bone) in the back of the foot where freeing the blockage can restore function.

After Care

Time off work depends on the type of work as well as the surgical procedures performed. . A patient will be required to be non-weight bearing in a cast or splint and use crutches for four to twelve weeks. Usually a patient can return to work in one to two weeks if they are able to work while seated. If a person's job requires standing and walking, return to work may take several weeks. Complete recovery may take six months to a full year. Complications can occur as with all surgeries, but are minimized by strictly following your surgeon's post-operative instructions. The main complications include infection, bone that is slow to heal or does not heal, progression or reoccurrence of deformity, a stiff foot, and the need for further surgery. Many of the above complications can be avoided by only putting weight on the operative foot when allowed by your surgeon.

Many children have one leg that is marginally longer than the other. In most cases, the difference is present at birth but may be too slight to be detected. More significant leg length differences (more than 2 cm) often become obvious as your child grows and begins to crawl and walk. We don?t always know what causes these discrepancies. A significant discrepancy can lead to more serious problems including arthritis and difficulty walking. However, with appropriate treatment, most children with this condition can participate in regular activities. Treatment options include heel lifts and, in more severe cases, surgery to either lengthen or shorten a leg.

Causes

Some children are born with absence or underdeveloped bones in the lower limbs e.g., congenital hemimelia. Others have a condition called hemihypertrophy that causes one side of the body to grow faster than the other. Sometimes, increased blood flow to one limb (as in a hemangioma or blood vessel tumor) stimulates growth to the limb. In other cases, injury or infection involving the epiphyseal plate (growth plate) of the femur or tibia inhibits or stops altogether the growth of the bone. Fractures healing in an overlapped position, even if the epiphyseal plate is not involved, can also cause limb length discrepancy. Neuromuscular problems like polio can also cause profound discrepancies, but thankfully, uncommon. Lastly, Wilms? tumor of the kidney in a child can cause hypertrophy of the lower limb on the same side. It is therefore important in a young child with hemihypertrophy to have an abdominal ultrasound exam done to rule out Wilms? tumor. It is important to distinguish true leg length discrepancy from apparent leg length discrepancy. Apparent discrepancy is due to an instability of the hip, that allows the proximal femur to migrate proximally, or due to an adduction or abduction contracture of the hip that causes pelvic obliquity, so that one hip is higher than the other. When the patient stands, it gives the impression of leg length discrepancy, when the problem is actually in the hip.

Symptoms

The symptoms of limb deformity can range from a mild difference in the appearance of a leg or arm to major loss of function of the use of an extremity. For instance, you may notice that your child has a significant limp. If there is deformity in the extremity, the patient may develop arthritis as he or she gets older, especially if the lower extremities are involved. Patients often present due to the appearance of the extremity (it looks different from the other side).

Diagnosis

A systematic and well organized approach should be used in the diagnosis of LLD to ensure all relevant factors are considered and no clues are overlooked which could explain the difference. To determine the asymmetry a patient should be evaluated whilst standing and walking. During the process special care should be used to note the extent of pelvic shift from side to side and deviation along the plane of the front or leading leg as well as the traverse deviation of the back leg and abnormal curvature of the spine. Dynamic gait analysis should be conducted during waling where observation of movement on the sagittal, frontal and transverse planes should be noted. Also observe head, neck and shoulder movements for any tilting.

Non Surgical Treatment

For minor limb length discrepancy in patients with no deformity, treatment may not be necessary. Because the risks may outweigh the benefits, surgical treatment to equalize leg lengths is usually not recommended if the difference is less than 1 inch. For these small differences, the physician may recommend a shoe lift. A lift fitted to the shoe can often improve walking and running, as well as relieve any back pain that may be caused by the limb length discrepancy. Shoe lifts are inexpensive and can be removed if they are not effective.

Lengthening is usually done by corticotomy and gradual distraction. This technique can result in lengthenings of 25% or more, but typically lengthening of 15%, or about 6 cm, is recommended. The limits of lengthening depend on patient tolerance, bony consolidation, maintenance of range of motion, and stability of the joints above and below the lengthened limb. Numerous fixation devices are available, such as the ring fixator with fine wires, monolateral fixator with half pins, or a hybrid frame. The choice of fixation device depends on the desired goal. A monolateral device is easier to apply and better tolerated by the patient. The disadvantages of monolateral fixation devices include the limitation of the degree of angular correction that can concurrently be obtained; the cantilever effect on the pins, which may result in angular deformity, especially when lengthening the femur in large patients; and the difficulty in making adjustments without placing new pins. Monolateral fixators appear to have a similar success rate as circular fixators, especially with more modest lengthenings (20%).

Plantar Fasciitis, also known as heel pain or a heel spur, is a musculoskeletal condition causing pain under the heel or into the inner arch of the foot. The condition is commonly mistaken for an impact trauma or heel bruise but in fact it is caused by mechanical overstretching of the fibrous tissue in the arch. Heel pain can develop suddenly or evolve gradually over time. It can affect people of all ages, but is more common beyond the 4th decade of life, those in standing occupations, overweight individuals and those involved in regular strenuous exercise.

Causes

There are many reasons why people experience heel pain. Based on what we see in our office, heel pain affects, probably more than one in every four people. A lot of this is caused from conditions within the foot. These conditions could be related to hyper pronation, which is where you get a collapse of the foot or even a high arch of the foot called cavus foot. The underlying cause is something internal, within the bone structure. These problems are usually something you will have all your life. Hyper pronation is a hereditary issue where you can get an under development of a particular bone, usually in the ankle, and it causes a dislocation or a misalignment of the ankle on the heel. It throws off, not only the foot with the bones, joints and ligaments of the foot, but also the bones in the ankle. It affects the internal rotation of the knee, hip, back and causes issues within those areas as well. Hyper pronation is a pretty common, but very under diagnosed condition.

Symptoms

Initially, this pain may only be present when first standing up after sleeping or sitting. As you walk around, the muscle and tendon loosen and the pain goes away. As this problem progresses, the pain can be present with all standing and walking. You may notice a knot or bump on the back of the heel. Swelling may develop. In some cases, pressure from the back of the shoe causes pain.

Diagnosis

In most cases, your GP or a podiatrist (a specialist in foot problems and foot care) should be able to diagnose the cause of your heel pain by asking about your symptoms and medical history, examining your heel and foot.

Non Surgical Treatment

Anti-inflammatory medication. Heel stretching exercise. Ice application to painful area - twice a day or more, for 10 - 15 minutes. Rest. Supportive, well-fitting, padded shoes. Heel cup, felt pads or orthotics. Night splints - stretches injured fascia and allows healing. Basic treatment. First thing in the morning, before getting out of bed -- massage the bottom of the affected foot or feet for at least five minutes. Ensure that the plantar is stretched and warmed up so that overnight healing remains intact. Before stepping out of bed, be sure that you have soft, padded, supportive shoes or slippers to wear, especially if your flooring is hard, tile or uncarpeted flooring.

Surgical Treatment

At most 95% of heel pain can be treated without surgery. A very low percentage of people really need to have surgery on the heel. It is a biomechanical problem and it?s very imperative that you not only get evaluated, but receive care immediately. Having heel pain is like having a problem with your eyes; as you would get glasses to correct your eyes, you should look into orthotics to correct your foot. Orthotics are sort of like glasses for the feet. They correct and realign the foot to put them into neutral or normal position to really prevent heel pain, and many other foot issues. Whether it be bunions, hammertoes, neuromas, or even ankle instability, a custom orthotic is something worth considering.

Being overweight can place excess pressure and strain on your feet, particularly on your heels. Losing weight, and maintaining a healthy weight by combining regular exercise with a healthy, balanced diet, can be beneficial for your feet. Wearing appropriate footwear is also important. Ideally, you should wear shoes with a low to moderate heel that supports and cushions your arches and heels. Avoid wearing shoes with no heels.

Morton's neuroma is an inflammation of the nerves in the foot that go to the toes. Although the name includes the word ?neuroma,? it is not really a tumor. It can affect any of the toes in the foot. However, it most often affects the nerves that run between the third and fourth, or second and third toes.

Causes

The exact cause is as yet unclear. However there are a number of theories. Some expert s believe problems with the design of the foot makes some people more prone to Morton?s neuroma. Having flat feet or a high arch for example encourages the foot to slide forwards which can put excess pressure on the metatarsals. Bunions and hammer toes also increase the likelihood of developing Morton?s. However simply wearing high heels or any form of tight shoes that put pressure on the bones in the feet can also lead to a Morton?s . Typically the condition comes on between the age of 40 and 50. It is far more common in women than men - three out of four sufferers are women.

Symptoms

Often, no outward signs (such as a lump or unusual swelling) appear from the condition. Neuroma pain is most often described as a burning discomfort in the forefoot. Aching or sudden shooting pain in the forefoot is also common. All running sports, especially distance running can leave an athlete vulnerable to Morton?s Neuroma, which may appear or flare up in the middle of a run or at the end. The sufferer often has the desire to remove his shoe and rub the afflicted foot. Should the Neuroma be of sufficient size, or if footwear is particularly tight or uncomfortable, the painful condition may be present during normal walking. Numbness in the foot may precede or accompany Neuroma pain.

Diagnosis

The doctor will perform an examination of your feet as well. He or she may palpate your feet and flex them in specific ways that will indicate the presence of a neuroma. X-rays are often used to rule out other problems, such as fractures, bone spurs, arthritis or other problems with the bones in the toes or foot. In some cases, an MRI (magnetic resonance imaging) may be helpful to confirm the presence of a neuroma.

Non Surgical Treatment

Treatment depends on the severity of your symptoms. Your doctor will likely recommend trying conservative approaches first. Arch supports and foot pads fit inside your shoe and help reduce pressure on the nerve. These can be purchased over-the-counter, or your doctor may prescribe a custom-made, individually designed shoe insert, molded to fit the exact contours of your foot.

Surgical Treatment

When early treatments fail and the neuroma progresses past the threshold for such options, podiatric surgery may become necessary. The procedure, which removes the inflamed and enlarged nerve, can usually be conducted on an outpatient basis, with a recovery time that is often just a few weeks. Your podiatric physician will thoroughly describe the surgical procedures to be used and the results you can expect. Any pain following surgery is easily managed with medications prescribed by your podiatrist.

There are not one but two unique variations of leg length discrepancies, congenital and acquired. Congenital indicates that you are born with it. One leg is anatomically shorter compared to the other. Through developmental periods of aging, the brain picks up on the walking pattern and identifies some variance. The human body typically adapts by dipping one shoulder to the "short" side. A difference of less than a quarter inch is not grossly uncommon, require Shoe Lifts to compensate and mostly does not have a profound effect over a lifetime.

Leg length inequality goes largely undiagnosed on a daily basis, however this issue is very easily solved, and can eliminate many instances of low back pain.

Therapy for leg length inequality usually involves Shoe Lifts. Many are affordable, commonly costing under twenty dollars, compared to a custom orthotic of $200 and up. When the amount of leg length inequality begins to exceed half an inch, a whole sole lift is generally the better choice than a heel lift. This prevents the foot from being unnecessarily stressed in an abnormal position.

Upper back pain is the most widespread ailment impacting men and women today. Over 80 million people suffer from back pain at some stage in their life. It is a problem which costs companies huge amounts of money every year as a result of time lost and production. New and better treatment methods are constantly sought after in the hope of decreasing the economic influence this condition causes.

Men and women from all corners of the world suffer the pain of foot ache as a result of leg length discrepancy. In most of these cases Shoe Lifts are usually of very helpful. The lifts are capable of relieving any discomfort in the feet. Shoe Lifts are recommended by countless experienced orthopaedic doctors.

In order to support the body in a nicely balanced manner, your feet have a critical job to play. In spite of that, it is often the most overlooked region of the human body. Some people have flat-feet which means there may be unequal force placed on the feet. This will cause other body parts such as knees, ankles and backs to be affected too. Shoe Lifts ensure that correct posture and balance are restored.

Bone spurs are bony projections that develop along the edges of bones. Bone spurs (osteophytes) often form where bones meet each other - in your joints. They can also form on the bones of your spine. The main cause of bone spurs is the joint damage associated with osteoarthritis. Most bone spurs cause no symptoms and may go undetected for years. They may not require treatment. Decisions about treatment depend on where spurs are situated and how they affect your health.

Causes

A heel spur is caused by chronic plantar fasciitis. Your plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes.Your plantar fascia acts as a passive limitation to the over flattening of you arch. When your plantar fascia develops micro tears or becomes inflamed it is known as plantar fasciitis. When plantar fasciitis healing is delayed or injury persists, your body repairs the weak and injured soft tissue with bone. Usually your injured fascia will be healed via fibroblastic activity. They'll operate for at least six weeks. If your injury persists beyond this time, osteoblasts are recruited to the area. Osteoblasts form bone and the end result is bone (or calcification) within the plantar fascia or at the calcaneal insertion. These bone formations are known as heel spurs. This scenario is most common in the traction type injury. The additional bone growth is known as a heel spur or calcaneal spur.

Symptoms

Pain and discomfort associated with heel spurs does not occur from the spur itself. The bone growth itself has no feeling. However, as you move, this growth digs into sensitive nerves and tissue along the heel of the foot, resulting in severe pain. Pain can also be generated when pushing off with the toes while walking. Swelling along the heel is also common.

Diagnosis

Your doctor will discuss your medical history and will examine your foot and heel for any deformities and inflammation (swelling, redness, heat, pain). He/she will analyze your flexibility, stability, and gait (the way you walk). Occasionally an x-ray or blood tests (to rule out diseases or infections) may be requested.

Non Surgical Treatment

The majority of heel spurs are treated with non-surgical interventions. These can relieve pain, but may take from about 3 months to up to a year for symptoms to resolve. Rest, icing, and over-the-counter anti-inflammatory or prescription medications can help ease symptoms. Cortisone injections may also be used. Physical therapists may instruct you to perform stretching exercises to help relax the tissues in the heel. Your doctor may recommend custom orthotics or shoe inserts to position and cushion your heel. Night splints can help position the heel and arch of the foot while you sleep. Some doctors may recommend extracorporeal shock wave therapy (ESWT). This treatment uses energy pulses to start the repair process in the heel tissues. ESWT is recommend when other non-surgical treatments have failed.

Surgical Treatment

Surgery is used a very small percentage of the time. It is usually considered after trying non-surgical treatments for at least a year. Plantar fascia release surgery is use to relax the plantar fascia. This surgery is commonly paired with tarsal tunnel release surgery. Surgery is successful for the majority of people.

Prevention

A variety of steps can be taken to avoid heel pain and accompanying afflictions. Wear shoes that fit well-front, back, and sides-and have shock-absorbent soles, rigid shanks, and supportive heel counters. Wear the proper shoes for each activity. Do not wear shoes with excessive wear on heels or soles. Prepare properly before exercising. Warm up and do stretching exercises before and after running. Pace yourself when you participate in athletic activities. Don't underestimate your body's need for rest and good nutrition. If obese, lose weight.

Heel spurs, pointed, bony outgrowths of the heel, are caused by localized soft tissue inflammation and can be located at the back of the heel or under the heel, beneath the sole of the foot. Plantar fascitis is associated with inflammation caused by heel spurs on the soles of the feet. Both conditions are treated with ice application and anti-inflammatory medications. Orthotics may also provide some relief.

Causes

Heel spurs develop in some people that have a condition called plantar fasciitis, inflammation of the plantar fascia. Heel spurs form when the plantar fascia separates from the calcaneus. An abnormal bone growth, a hook-like spur, forms from calcium deposits that grow at the site of inflammation. Heel spurs are more common in middle-aged adults and people that have had plantar fasciitis for a long time. People with flat feet or high arches are vulnerable to heel spurs. Women who wear high-heeled shoes are more susceptible, as well.

Symptoms

The following symptoms are typical of heel spur. Stabbing pain when treading on the area affected. Dull, irregularly occurring pains in the heel area also without exerting pressure (e.g. in a reclining position) Pain when taking the first steps in the morning (after lying or sitting down for an extended period, especially in the morning) Occasional swelling in the ankle area. For the lower heel spur, extreme sensitivity at the tendon attachment (laterally in the lower heel area) For the upper heel spur, extreme pressure sensitivity of the Achilles tendon, primarily at approximately ankle height.

Diagnosis

The proper diagnosis of a heel spur often requires an X-ray. To make this process as convenient for his patients as possible, most clinics have an on-site digital X-ray and diagnostic ultrasound machines. This can make it unnecessary for patients to visit diagnostic imaging centers, allowing patients to receive more expedient treatment.

Non Surgical Treatment

The key for the proper treatment of heel spurs is determining what is causing the excessive stretching of the plantar fascia. When the cause is over-pronation (flat feet), an orthotic with rear foot posting and longitudinal arch support is an effective device to reduce the over-pronation, and allow the condition to heal. Other common treatments include stretching exercises, losing weight, wearing shoes that have a cushioned heel that absorbs shock, and elevating the heel with the use of a heel cradle, heel cup, or orthotic. Heel cradles and heel cups provide extra comfort and cushion to the heel, and reduce the amount of shock and shear forces experienced from everyday activities.

Surgical Treatment

In a small number of cases (usually less than 5 percent), patients may not experience relief after trying the recommendations listed above. It is important that conservative treatments (such as those listed above) be performed for AT LEAST a year before considering surgery. Time is important in curing the pain from heel spurs, and insufficient treatment before surgery may subject you to potential complications from the procedure. If these treatments fail, your doctor may consider an operation to loosen the plantar fascia, called a plantar fascia release.